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Sample SR-22 Form

Sample SR-22 Form
This sample SR-22 form for the state of CA is what your insurance agent may issue for you as proof of auto liability coverage to meet the sate requirements for an SR-22. This form is what you need to present to the DMV to reinstate your driving privileges along with your reinstatement fee.

SR22 Form - Sample SR22
An SR-22 may be required of you if you are arrested and/or convicted of a DUI/DWI, Negligent Driving, or perhaps a “Wet Wreckless” and who are in a program and who want to get their driving privileges back.
To get your driver’s license back after your arrest or conviction you must do these 3 things:
  1. Pay a re-issue fee
  2. Show proof of financial responsibility (SR-22)
  3. Show proof of enrollment in an approved DUI program.
Proof of insurance must be kept for a term of up to three years (from the date of your suspension being over). Proof of insurance must stay active (and there is no need to keep re-submitting an SR-22) if you do not cancel the coverage or get dropped during that 3-year time frame. The insurance policy that the SR-22 is filed under must remain in effect. If for any reason the policy is no longer in force the insurance company is REQUIRED by law to notify the DMV. This may result in IMMEDIATE suspension of your driving privileges and another re-issue fee by the DMV.

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